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Introduction. Conjoined twins, also known as Siamese twins, represent one of the rarest anomalies of monozygotic pregnancies that have fascinated both medical world and the general public. The incidence of this anomaly varies between 1:50.000 and 1:100.000 births, and there is a higher predisposition toward female gender, with a ratio of 3:1. Conjoined twins appear from abnormal embryogenesis, the two main theories proposed for explaining the occurrence of this anomaly being fusion and fission. Conjoined twins were classified by Spencer (1996), and are named according to the most prominent site of fusion. The conjoined site may be in the ventral, dorsal or lateral groups. The extent of organ sharing, especially the heart, determines the possibility and prognosis of a separation procedure. Materials and method. The aim of this paper is to offer an overview of the literature regarding this rare anomaly of monoamniotic monochorionic twin pregnancy and to present the case of a 35-year-old multiparous patient (six previous pregnancies) who was referred to our hospital for the confirmation of the thoracopagus conjoined twins diagnosis and for management. Results. With the current findings, the diagnosis of thoracopagus twin pregnancy was established. The family was informed and counseled on the various management options. Due to the presence of a common heart, the termination option was offered and the family accepted. The termination of pregnancy was made through caesarean section, resulting two female twins of approximately 500 g in total which were sent to the pathologist. Conclusions. Conjoined twin pregnancy is a rare finding. Establishing a diagnosis using ultrasound examination early during pregnancy offers the possibility of assessing the prognosis of the pregnancy, based on the organs that are shared by the fetuses, to offer the patient and her family a prognostic and, if possible, the treatment options. [ABSTRACT FROM AUTHOR]

Introduction. Conjoined twins, also known as Siamese twins, represent one of the rarest anomalies of monozygotic pregnancies that have fascinated both medical world and the general public. The incidence of this anomaly varies between 1:50.000 and 1:100.000 births, and there is a higher predisposition toward female gender, with a ratio of 3:1. Conjoined twins appear from abnormal embryogenesis, the two main theories proposed for explaining the occurrence of this anomaly being fusion and fission. Conjoined twins were classified by Spencer (1996), and are named according to the most prominent site of fusion. The conjoined site may be in the ventral, dorsal or lateral groups. The extent of organ sharing, especially the heart, determines the possibility and prognosis of a separation procedure. Materials and method. The aim of this paper is to offer an overview of the literature regarding this rare anomaly of monoamniotic monochorionic twin pregnancy and to present the case of a 35 year old multiparous patient (six previous pregnancies) who was referred to our hospital for the confirmation of the thoracopagus conjoined twins diagnosis and for management. Results. With the current findings, the diagnosis of thoracopagus twin pregnancy was established. The family was informed and counseled on the various management options. Due to the presence of a common heart, the termination option was offered and the family accepted. The termination of pregnancy was made through caesarean section, resulting two female twins of approximately 500 g in total which were sent to the pathologist. Conclusions. Conjoined twin pregnancy is a rare finding. Establishing a diagnosis using ultrasound examination early during pregnancy offers the possibility of assessing the prognosis of the pregnancy, based on the organs that are shared by the fetuses, to offer the patient and her family a prognostic and, if possible, the treatment options. [ABSTRACT FROM AUTHOR]

Late first-stage or second-stage caesarean section is commonly associated with fetal head impaction, leading to maternal and neonatal complications. This situation requires safe delivery techniques, but the optimal management remains controversial. The aim of this meta-synthesis was to compare maternal and neonatal outcomes associated with delivery techniques via caesarean section. Methodology. An electronic search of three databases, from inception to June 2021, was conducted. Cohort and randomized comparative studies on maternal and neonatal outcomes associated with techniques to deliver an impacted fetal head during caesarean section were included. The methodological quality of the primary studies was assessed. Review Manager 5.4 was used for statistical analyses. Nineteen articles, including 2345 women, were analyzed. Results. Three fetal extraction techniques were identified. Meta-analyses showed that the “pull” technique carries lower risks as compared to the “push” technique, and that the Patwardhan technique is safer compared to the “push” or the “push and pull” technique. Nine out of 11 quality criteria of the included studies were fully met. The “push” and the “pull” techniques were investigated by most included studies. The “pull” technique showed lower risks of blood transfusion (p=0.03), extension of uterine incision (p<0.00001), infection (p=0.003) and pyrexia (p<0.00001) compared to the “push” method. Conclusions. In the absence of robust evidence to support the use of a specific technique, the choice of the obstetrician should be based on best available evidence. Our study suggests that the “pull”, as well as the Patwardhan technique represent safe options to deliver an impacted fetal head. [ABSTRACT FROM AUTHOR]

Introduction. Late first-stage or second-stage caesarean section is commonly associated with fetal head impaction, leading to maternal and neonatal complications. This situation requires safe delivery techniques, but the optimal management remains controversial. The aim of this meta-synthesis was to compare maternal and neonatal outcomes associated with delivery techniques via caesarean section. Methodology. An electronic search of three databases, from inception to June 2021, was conducted. Cohort and randomized comparative studies on maternal and neonatal outcomes associated with techniques to deliver an impacted fetal head during caesarean section were included. The methodological quality of the primary studies was assessed. Review Manager 5.4 was used for statistical analyses. Nineteen articles, including 2345 women, were analyzed. Results. Three fetal extraction techniques were identified. Meta-analyses showed that the “pull” technique carries lower risks as compared to the “push” technique, and that the Patwardhan technique is safer compared to the “push” or the “push and pull” technique. Nine out of 11 quality criteria of the included studies were fully met. The “push” and the “pull” techniques were investigated by most included studies. The “pull” technique showed lower risks of blood transfusion (p=0.03), extension of uterine incision (p<0.00001), infection (p=0.003) and pyrexia (p<0.00001) compared to the “push” method. Conclusions. In the absence of robust evidence to support the use of a specific technique, the choice of the obstetrician should be based on best available evidence. Our study suggests that the “pull”, as well as the Patwardhan technique represent safe options to deliver an impacted fetal head. [ABSTRACT FROM AUTHOR]